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Fee Schedule Update

July 26, 2012

Blue Cross and Blue Shield of Texas (BCBSTX) will implement changes in the maximum allowable fee schedule used for BlueChoice®, HMO Blue® Texas (Independent Provider Network and THE Limited Network only), and ParPlan effective November 1, 2012.

  • The methodology used to develop the maximum allowable fee schedule will continue to be based on 2011 CMS values for those services for which the Blue Cross and Blue Shield of Texas reimbursement is based on CMS values.   
  • Reimbursement percentages for the modifiers 53, 54, 55, 56, 73, 74, 80, 81, 82 and AS will be revised.
  • Geographic Practice Cost Indices (GPCIs) will not be applied to the relative values so the relative values will not differ by Medicare locality.   
  • HMO Blue Texas, BlueChoice, and ParPlan relative values will consider the site of service where the service is performed (facility or non-facility).           
  • The Drug CPT/HCPCS Fee Schedule will be updated on the following dates:  9/1/2012, 12/1/2012, 3/1/2013 and 6/1/2013. 


Blue Cross and Blue Shield of Texas provides general reimbursement information policies, request forms for allowable fees and fee schedule information at bcbstx.com/provider.  To view this information, visit the General Reimbursement Information section on this website.  If you would like to request a sample of maximum allowable fees or if you have any other questions, please contact your local Professional Provider Network office.        

Reimbursement changes will be posted under "Reimbursement/Changes & Updates" in the Professional Schedules section on the BCBSTX provider website.  The changes will not become effective until at least 90 days from the posting date. The specific effective date will be noted for each change that is posted.